1 A mother brings her 6-yr-old son to his pediatrician because he has been having recurrent

. nosebleeds. Physical examination reveals diffuse petechiae and purpura. Laboratory studies show a
Hb of 9.0 g/L, platelet count of 20,000/cu.mm, & leukocyte count of 14,500/cu mm. Bone marrow
smear is shown below. The large cells are most probably precursors of

a.

Eosinophils

b.

Basophils

c.

Neutrophils

d.

Lymphocytes

e.

Monocytes

f.
g.

RBC
Platelets

2 Release of which of the following peptides leads to an increase in the secretion of pancreatic
. bicarbonates into the small intestine?
a.

Cholecystokinin

b.

Gastrin

c.

Motilin

d.

Secretin

e.

Somatostatin

3 A 6 -year-old boy playing in a dusty field in windy weather inhales many very small particles that
. become lodged in his terminal bronchioles. Which of the following are most important in cleaning the

particles?
a.

Type I pneumocytes

b.

Type II pneumocytes

c.

Alveolar macrophages

d.

Submucosal glands

e.

Ciliated cells

4 Which of the following substances use a protein-carrier molecule to traverse the cell membrane?
.
a.

Water

b.

Oxygen

c.

Glucose

d.

Alcohol

e.

Glycerol

5 A 78-year-old woman has a mean arterial pressure of 100 mm Hg and a heart rate of 62/min. She
. has a stroke volume of 80 mL and a right atrial pressure of 0 mm Hg. What is the total peripheral
resistance (in mm Hg/mL/min) in this woman?
a.

0.2

b.

0.1

c.

0.5

d.

0.3

e.

0.4

6 An 8-yr-old boy has had an upper respiratory infection for the past 3 days. Today, he is brought to
. the pediatrician by his mother, who says that he looks yellow. Physical examination shows pallor
and icterus. Laboratory studies reveal a Hb of 9.0 g/L, reticulocytes constituting 10.8%, platelets of
218,000/cu mm, and leukocyte count of 7,500/cu mm. A probable diagnosis of spherocytosis was
made. The peripheral smear which is shown below indicates

a.

Normal RBC

b.

Hypochromic RBC

c.

Defect in Spectrin

d.

Microcytic RBC

7 A 34-year-old male patient visited the emergency room with complaints of severe vomiting.
. Laborotaory examination of the vomitus is found to contain gastric contents including hydrochloric
acid. The patients condition is most likely associated with which of the following acid-base
disturbances?
a.

High anion gap metabolic acidosis

b.

Normal anion gap metabolic acidosis

c.

Respiratory acidosis

d.

Respiratory alkalosis

e.

Metabolic alkalosis

8 Basophils are increased in which of the following conditions?

.
a.

Acute infection

b.

Chronic infection

c.

Parasitic infestation

d.

Allergic reaction

9 A researcher is studying the effect of various manipulations on kidney blood flow and glomerular
. filtration. Which of the following is most likely to increase both renal plasma flow and peritubular
capillary pressure but decrease the glomerular capillary pressure?
a.

Constrict afferent arteriole

b.

Dilate afferent arteriole

c.

Constrict efferent arteriole

d.

Dilate efferent arteriole

1 If the above researcher dilates the afferent arteriole then which of the following changes will be seen
0 in renal plasma flow, peritubular capillary pressure, and glomerular capillary pressure respectively?
.
a.

Increases, increases, and increases

b.

Decreases, decreases, and decreases

c.

Decreases, decreases, and increases

d.

Increases, increases, and decreases

1 The vascular systems of five organs are arranged as shown in the drawing below. The vascular
1 resistance of each organ is the same and the total resistance of the entire circuit is 2.0 mm
. Hg/mL/min. What is the individual vascular resistance (mm Hg/mL/min) of each organ?

a.

10

b.

c.

d.

e.

f.

1 In the above picture, which of the following values is the total resistance of the entire circuit if
2 another organ with the same invidual vascular resistance (mm Hg/mL/min) was added to the circuit
. shown in the picture above?
a.

0.6

b.

1.0

c.

1.6

d.

2.0

e.

2.6

1 A 65-year-old male was brought to the ER with severe chest pain, sweating and nausea. EKG showed
3 ST elevation in leads II, III and aVF. Medical management of acute myocardial infarction was
. initiated. After initial treatment the pain decreased in intensity, but a reperfusion complex ventricular
arrhythmia emerged. The arrhythmia was asymptomatic and resolved spontaneously. Which of the
following drug was most likely responsible for rapid reperfusion in this patient?
a.

Heparin

b.

Argatroban

c.

Warfarin

d.

tPA

e.

Aspirin

1 A 54-year-old male is being evaluated for lung disease. Ventilator function testing reveals a
4 decreased forced vital capacity, and a FEV1 /FVC ratio of 60%. The most likely diagnosis in this
.

patient is
a.

Pulmonary fibrosis

b.

Interstitial lung disease

c.

Pleural effusion

d.

Pericardial effusion

e.

Emphysema

1
Which of the following factors inhibit erythropoietin production?
5
.
a.

Low blood volume

b.

Anemia

c.

Low Hb

d.

Normal blood flow

e.

Pulmonary diseases

1 A patient came with bone pain and abdominal cramps. Examination revealed depressed mood. X-ray
6 revealed a 0.5 mm stone in the left ureter. Based on these findings, which of the following is the
. likely diagnosis in this patient?
a.

Hyperparathyroidism

b.

Hypoarathyroidism

c.

Hyperthryoidism

d.

Hypopituitarism

e.

Hyperpituitarism

1 During a fast, a brief phase of intense sequential contractions begins in the stomach and gradually
7 migrates to
. the ileum. Release of which of the following intestinal hormones is most likely responsible for this
observed

effect?
a.

Cholecystokinin

b.

Gastrin

c.

Gastrin-releasing peptide

d.

Motilin

e.

Secretin

f.

Somatostatin

1 A 55-year-old caucasian female presents to the clinic complaining of weight gain and easy
8 fatiguability. She takes a multi-vitamin and some over-the-counter medications for constipation. Her
. blood pressure is 140/96 mm Hg and her heart rate is 55/min. Physical examination reveals a
delayed relaxation of the knee and ankle reflexes. Skin is very dry and thick. What is the most likely
diagnosis in this patient?
a.

Hyperthyroidism

b.

Hyperparathyroidism

c.

Hypothyroidism

d.

Hypoparathyroidism

e.

Hyperaldosteronism

1 Which of the following parameters will be seen in the base of the lung in comparision to the apex in a
9 normal healthy individual?
.
a.

Perfusion decreased, V/Q increased

b.

Perfusion increased, V/Q decreased

c.

Perfusion decreased, V/Q decreased

d.

Perfusion increased, V/Q increased

2 Gastric inhibitory peptide is an important gastrointestinal hormone. The cells producing it and the
0

. functions of the peptide respectively are

a.

K cells and inhibits insulin release

b.

M cells and stimulates gastric motility

c.

S cells and inhibits gastric acid secretion

d.

M cells and stimulates intestinal motility

e.

K cells and stimulates insulin release

f.

S cells and stimulates pepsin secretion

2 In the ECG given below, what is the most likely diagnosis?

1
.

a.

RBBB

b.

RVH

c.

LBBB

d.

LVH

2 A person who is suffering with severe claustrophobia (fear of closed spaces) was locked accidentally
2 in a closet for some amount of time. If the blood of this patient was analyzed then which of the
. following sets of lab findings is most likely to be found in this patient?

a.

1. pH of 7.29; PaCO2 of 50 mmHg; & HCO3- of 18 mEq/L

b.

2. pH of 7.61; PaCO2 of 32 mmHg; & HCO3- of 28 mEq/L

c.

3. pH of 7.32; PaCO2 of 34 mmHg; & HCO3- of 18 mEq/L

d.

4. pH of 7.43; PaCO2 of 50 mmHg; & HCO3- of 40 mEq/L

e.

5. pH of 7.26; PaCO2 of 50 mmHg; & HCO3- of 35 mEq/L

f.

6. pH of 7.52; PaCO2 of 30 mmHg; & HCO3- of 18 mEq/L

2 In the above sets of lab findings, which set will correspond to a patient suffering with Conns
3 syndrome?
.
a.

b.

c.

d.

e.

f.

2 Transport of glucose from the intestinal lumen into a small intestinal cell is inhibited when the usual
4 Na+ gradient across the membrane is abolished. This would suggest inhibition of which of the
. following transport mechanisms?
a.

Simple diffusion

b.

Facilitated diffusion

c.

Primary active transport

d.

Cotransport

e.

Countertransport

2 On routine physical examination, a 21-year-old Caucasian male is found to have only one testis in his

5 scrotum. Further evaluation reveals an elevated serum FSH level and a normal serum LH level.
. Production of which of the following substances is likely to be impaired in this patient?
a.

Testosterone

b.

Dihydrotestosterone

c.

DHEA

d.

Inhibin B

e.

Cortisol

2 The blood of a patient is tested in the lab for grouping and typing. The blood did not react when A
6 and B antibodies were added but reacted when D antibodies are added. The patient's blood group
. based on the above reactions is
a.

A positive

b.

B positive

c.

AB positive

d.

O positive

e.

A negative

f.
g.

B negative
AB negative

2 A series of photographs taken of a middle-aged man over a period of two decades demonstrates
7 gradual coarsening of facial features and progressive protrusion of the brows. Upon questioning, the
. patient reports having to wear larger shoes than he did as a young man. MRI scan revealed the
presence of hypothalamic tumor. Which of the following changes can be seen in this partiular case?
a.

GH increase, GHRH decrease, Somatostatin decrease

b.

GH decrease, GHRH increase, Somatostatin decrease

c.

GH increase, GHRH increase, Somatostatin increase

d.

GH increase, GHRH decrease, Somatostatin increase

e.

GH decrease, GHRH decrease, Somatostatin decrease

2
Which of the following characteristics is shared by simple and facilitated diffusion of glucose?
8
.
a.

Is saturable

b.

Requires metabolic energy

c.

Is inhibited by the presence of galactose

d.

Occurs down an electrochemical gradient

e.

Requires a Na+ Gradient

2
Which of the following tests is used for measuring specifically intrinsic pathway?
9
.
a.

Prothrombin time

b.

Bleeding time

c.

Clotting time

d.

aPTT (partial thromboplastin time)

3 Prior to a major abdominal surgery a patient was found to have low levels of vitamin K. Which of the
0 following clotting factors would be decreased in this patient?
.
a.

b.

III

c.

d.

VII

e.

XI

3 On performing an arterial blood analysis in a patient the physician noted that the pH and HCO31 levels are decreased but PCO2 level is increased. Which of the following conditions best describes this

. patients problem?
a.

Respiratory acidosis

b.

Respiratory alkalosis

c.

Metabolic acidosis

d.

Metabolic alkalosis

e.

Mixed acidosis

f.

Mixed alkalosis

3
Which of the following is true about the secretion from the exocrine pancreas?
2
.
a.

It has a higher Cl- concentration than does plasma

b.

It is stimulated by the presence of HCO3- in the duodenum

c.

Pancreatic secretion is increased by gastrin

d.

Pancreatic enzyme secretion is increased by cholecystokinin (CCK)

e.

It is hypotonic

3
Which of the following hormones maintains the corpus luteum of pregnancy?
3
.
a.

GnRH

b.

FSH

c.

hCG

d.

Progesterone

e.

Estrogen

f.

Prolactin

3
The hormone responsible for stimulating milk production from a lactating mammary gland is
4
.
a.

Prolactin

b.

Vasopressin

c.

Oxytocin

d.

FSH

e.

LH

3 A 59-yr-old male patient is brought to the ER with complaints of chest pain, breathlessness,
5 palpitations, & sweating. Blood tests, ECG and Angiogram were done in this patient and flow rates
. were measured. It is a known fact that for a given vessel length, flow depends on radius, pressure
gradients, and viscosity. Angiogram revealed an atherosclerotic plaque in the LAD that has reduced
the radius of the vessel by a factor of 2. The flow change only due to the plaque is:
a.

Increase by a factor of 2

b.

Decrease by a factor of 2

c.

Increase by a factor of 8

d.

Decrease by a factor of 8

e.

Increase by a factor of 16

f.

Decrease by a factor of 16

3 In the above patient, blood tests revealed that the patient is suffering with severe anemia with low
6 RBC count that reduced the hematocrit to 1/4th of its original value. The flow change only due to the
. hematocrit variation is:
a.

Increase by a factor of 2

b.

Decrease by a factor of 2

c.

Increase by a factor of 8

d.

Decrease by a factor of 8

e.

Increase by a factor of 4

f.

Decrease by a factor of 4

3 In the above patient, BP monitoring of the patient revealed a raise of systolic pressure from 120 to
7 160 while the diastolic pressure remained at 80 mm Hg. The flow change only due to the pressure
. gradient is:
a.

Increase by a factor of 2

b.

Decrease by a factor of 2

c.

Increase by a factor of 8

d.

Decrease by a factor of 8

e.

Increase by a factor of 4

f.

Decrease by a factor of 4

3 In the above patient, what would be the overall change in flow if we take into consideration all the 3
8 variations mentioned above together?
.
a.

Increase by a factor of 2

b.

Decrease by a factor of 2

c.

Increase by a factor of 8

d.

Decrease by a factor of 8

e.

Increase by a factor of 4

f.

Decrease by a factor of 4

3 A patient presents with complaints of chest pain, breathlessness on exertion, & syncope. After
9 performing an ECG exam on the patient they physician came to the conclusion that the patient is
. suffering with second-degree heart block. Which of the following ECGs represents this type of heart
block?
a.

b.

c.

d.

e.

f.

4 If the above patient was diagnosed to be suffering with atrial fibrillation then which of the above
0 ECGs will be seen in the patient?
.
a.

b.

c.

d.

e.

f.

4 In the above patient, if the diagnosis was changed to ventricular fibrillation then the above ECGs will
1 corresponding to this new diagnosis
.
a.

b.

c.

d.

e.

f.

4 A 65-year-old male with long history of chronic obstructive pulmonary disease (COPD) is brought to
2 the emergency room complaining of shortness of breath, fever, yellow sputum and lower extremity
. edema. Physical examination reveals cyanosis, finger clubbing and bilateral lung wheezes. Which of
the following findings is the most likely in this patient?
a.

Normal arterial blood oxygen content

b.

Normal mixed venous blood oxygen content

c.

Increased pH of the arterial blood

d.

Increased pulmonary arterial resistance

e.

Increased cerebral vascular resistance

4
Anemia is usually characterized by an increased:
3
.
a.

Hematocrit

b.

Blood viscosity

c.

Total peripheral resistance

d.

Exercise performance

e.

Work load on the heart

4 A young boy presents with failure to thrive. Biochemical analysis of a duodenal aspirate after a meal
4 reveals a
. deficiency of enteropeptidase (enterokinase). The levels of which of the following digestive enzymes
would be

affected?
a.

Amylase

b.

Colipase

c.

Lactase

d.

Pepsin

e.

Trypsin

4 The partial pressure of oxygen in the tracheal air of a resting, young, healthy patient is known to be
5 150 mmHg, however, when the alveolar oxygen partial pressure is tested, the pressure reads 80
. mmHg. This finding mostly likely indicates which of the following about this patient?
a.

A normal alveolar ventilation and perfusion

b.

Poor alveolar ventilation

c.

Poor alveolar perfusion

d.

Diffusion limited gas exchange

e.

Arteriovenous blood shunting

4 Carbon monoxide is a deadly gas and binds to hemoglobin when inhaled. It creates problems
6 because it binds to the same site as oxygen does, competing for the same binding site. This
. ultimately causes the erythrocyte to deliver carbon monoxide instead of oxygen to the tissues. Which
of the following is the binding site for carbon monoxide?
a.
b.

globin
amino acid

c.

copper

d.

iron

e.

manganese

4 A patient presents with fatigue and generalized weakness. Examination revealed significant pallor.
7 Peripheral blood smear which is shown below shows small and pale RBC. The patient will benefit with

. intake of

a.

Iodine

b.

Iron

c.

Vitamin B12

d.

Riboflavin

e.

Vitamin A

4 Angiography on a 63-year-old male reveals atherosclerotic narrowing of the right renal artery. The
8 left renal artery is intact. You conclude that the flow in the right-sided artery is decreased by a factor
. of 16 compared to the left. Thus, the degree of stenosis in the right renal artery is
a.

25%

b.

33%

c.

50%

d.

75%

e.

90%

4
Which of the following mechanisms help in acclimatization to high altitude?
9
.
a.

Decrease in pulmonary ventilation

b.

Decreased numbers of red blood cells

c.

Increased diffusing capacity of the lungs

d.

Decreased vascularity of the peripheral tissues

e.

Decreased ability of the tissue cells to use oxygen despite low Po2

5 A 70-year-old woman undergoes a gastrectomy for Zollinger-Ellison syndrome. Her doctor informs
0 her that she
. will need to take intramuscular vitamin B12 shots for the rest of her life. Absence of which of the
following cell
types is responsible for this vitamin replacement requirement?
a.

Chief cells

b.

G cells

c.

Goblet cells

d.

Mucous neck cells

e.

Parietal cells

5 The pulmonary volume curve for a 34-year-old male is shown on the slide below in comparison with
1 a normal curve (dashed line). Which of the following measures is increased in this patient?
.

a.

Forced vital capacity (FVC)

b.

Forced expiratory volume in one second (FEV1)

c.

FEV1/FVC

d.

Residual volume

e.

Tidal volume

5 A 24-yr-old male person was brought to the ER with severe hypovolemia following severe burns. How
2 does his Osmolality and volume for ECF and Osmolality and volume for ICF change respectively?
.
a.

Decrease, increase, decrease, and increase

b.

Decrease, decrease, decrease, and increase

c.

No change, increase, no change, and no change

d.

No change, decrease, no change, and no change

e.

Increase, increase, increase, and decrease

f.

Increase, decrease, increase, and decrease

5 Which of the following areas represents the volume of air inhaled or exhaled with each breath?
3
.

a.

BC

b.

CD

c.

DE

d.

BE

e.

CE

f.

AB

5
In the above picture, which area represents inspiratory capacity?
4
.
a.

CE

b.

DE

c.

BC

d.

AC

e.

BD

f.

BE

5
In the above picture, the area BE represents
5
.
a.

Tidal volume

b.

Forced inspiratory volume

c.

Inspiratory capacity

d.

Forced expiratory volume

e.

Vital capacity

f.

Functional residual capacity

5
In the above picture, the area AC represents
6
.
a.

Tidal volume

b.

Forced inspiratory volume

c.

Inspiratory capacity

d.

Forced expiratory volume

e.

Vital capacity

f.

Functional residual capacity

5 A patient visits the clinic complainig of confusion and disoreinetation. Investigations revealed cerebral
7 edema. CT chest revealed a lung tumor. Which of the following abnormalities would one find in this
. patient?
a.

Hyponatremia due to excess water

b.

Hyponatremia due to excess sodium loss

c.

Hypernatremia due to dehydration

d.

Hypernatremia due to excess sodium intake

5 A patient presents to the clinic with complaints of breathlessness and cough with sputum production.
8 The breathlessness has increased in recent days. X-ray and CT scan revealed the presence of a
. collapsed lobe in the right lung. This condition leads to
a.

Wasted ventilation (dead space)

b.

Venous admixture

c.

Wasted perfusion (shunt)

d.

Shifting in the hemoglobin diffusion curve

e.

Decreased tissue O2 utilization

5 What is the direction of the flow of the fluid in relation to the capillaries and what is the net
9 outward/inward pressure in a given tissue if the pressures are as follows
. Capillary hydrostatic pressure 55 mm Hg
Capillary oncotic pressure 34 mmHg
Interstitial fluid hydrostatic pressure 28 mm Hg
Tissue oncotic pressure 4 mmHg
a.

Inwards and 45 mm Hg

b.

Outwards and 3 mm Hg

c.

Inwards and 3 mm Hg

d.

Outwards and 57 mm Hg

e.

Inwards and 57 mm Hg

f.

Outwards and 45 mm Hg

6 In the above question, if the Interstitial fluid hydrostatic pressure was changed to negative 10 mm
0 Hg (-10 mm Hg), then what is the direction of the flow of the fluid in relation to the capillaries and
. what is the net Outward/Inward pressure?
a.

Inwards and 35 mm Hg

b.

Outwards and 7 mm Hg

c.

Inwards and 7 mm Hg

d.

Outwards and 83 mm Hg

e.

Inwards and 83 mm Hg

f.

Outwards and 35 mm Hg